The World Health Organization (WHO) has announced that everyone with HIV, regardless of their CD4 cell count, should begin antiretroviral therapy (ART) treatment as soon as possible.
The new guidelines will mean that 37 million people who currently live with HIV globally should be treated. In addition, the guidelines also recommend that all people at “substantial” risk of contracting HIV should also be given preventive ART treatment.
“This is a significant shift to increase the access to Anti-retroviral (ARV) therapy. The guidelines suggest that all people living with HIV should receive ARVs regardless of their CD4 count. In South Africa HIV infected patients can currently access ARVs once their CD4 count reaches 500,” said Right to Care CEO, Professor Ian Sanne.
“These new guidelines have rapidly incorporated the latest research findings as to when to start ART for adults. All adults irrespective of their CD4 count once diagnosed as HIV infected should be offered therapy,” said Southern African HIV Clinicians Society President, Dr Francesca Conradie.
According to Prof Sanne, national policies will need to consider “test and treat” strategies to maximise the number of people on ARV therapy.
Recent clinical trials have confirmed that early drug use extends the lives of those with the AIDS-causing virus and cuts the risk of disease transmission to partners.
“The guideline confirms the many research studies that have been published demonstrating a 92% reduction in HIV transmission with ARV therapy with sero-discordant couples – where one person is HIV-infected and the other is not – as well as a uniform benefit of treatment for patients on ARVs with a reduction in AIDS related opportunistic infection and TB,” explained professor Sanne.
As part of the new guidelines, all people at “substantial” risk of contracting HIV should be offered preventive ART treatment. The new recommendation builds on 2014 WHO guidance to offer a combination of ARV drugs to prevent HIV acquisition, pre-exposure prophylaxis (PrEP), for men who have sex with men.
“The addition of PrEP to those who are at substantial risk of HIV is also welcomed. In South Africa, at the present time the combination of TDF and FTC ARVs is not yet registered for PrEP. We would urge the regulatory authorities to expedite the registration,” said Dr Conradie.
WHO says PrEP should be seen as an additional prevention choice based on a comprehensive package of services, including HIV testing, counselling and support, and access to condoms and safe injection equipment.
“In South Africa, the Medicines Control Counsel has not yet approved ARVs for this indication and we hope that the WHO guidance document will accelerate the review process,” said professor Sanne.
UNAIDS estimates that by expanding ART to all people living with HIV and expanding prevention choices, 21 million AIDS-related deaths and 28 million new infections could be prevented by 2030.